Chorioamnionitis caused by Staphylococcus aureus in a ten weeks pregnant patient

Abstract

Infections are the most important causes of chorioamnionitis. Causative bacteria are usually genital mycobacteria, anaerobes, enteric Gram-negative bacilli and group B streptococci. Staphylococcus aureus can also rarely be the causative agent. In this study a case of chorioamnionitis caused by Staphylococcus aureus was reported. A ten weeks pregnant was admitted to our hospital with fever, physical examination revealed lower quadrant tenderness. Therapeutic abortion was planned for the patient whose fetal heart sounds were not heard by ultrasound. The meropenem treatment was administered to the patient with the pre-diagnosis of chorioamnionitis after obtainined cultures. Then Staphylococcus aureus was growed in the blood cultures and in the cultures of amniotic membranes obtained during operation. The histopathologic examination of the amniotic membranes was reported as acute funisit and acute chorioamnionitis. The therapy was continued with cefazoline and completed in 14 days. As a result Staphylococcus aureus should also be considered as a causative agent in chorioamnionitis cases and the empirical therapy should be administered accordingly

Keywords

• pregnancy, chorioamnionitis, Staphylococcus aureus

On haftalık gebede Staphylococcus aureus’un etken olduğu koryoamniyonit

Öz

Koryoamniyonite yol açan en önemli neden enfeksiyondur. Etken bakteriler genellikle genital mikoplazmalar, anaeroblar, enterik gram-negatif basiller ve grup B streptokoklardır. Nadiren Staphylococcus aureus’da etken olabilmektedir. Bu çalışmada S. aureus’un etken olduğu koryoamniyonit vakası sunulmuştur. On haftalık bir gebe, yüksek ateş şikayetiyle hastanemize başvurmuş, fizik muayenesinde batında alt kadran hassasiyeti saptanmıştır. Yapılan ultrasonografide fetüs kalp sesi duyulamayan hastaya teröpatik abortus planlanmıştır. Koryoamniyonit ön tanısıyla tüm kültürleri alındıktan sonra ampirik meropenem tedavisi başlanmıştır. Operasyon sırasında alınan amniyon zarı kültüründe ve kan kültürlerinde S. aureus üremiştir. Amniyon zarının histopatolojik incelemesi akut funisit ve akut koryoamniyonit olarak rapor edilmiştir. Tedaviye sefazolin ile devam edilmiş, tedavisi 14 güne tamamlanmıştır. Sonuç olarak koryoamniyonit düşünülen hastalarda nadiren S. aureus’un da etken olabileceği bilinmeli ve ampirik antibiyotik tedavisi buna göre düzenlenmelidir

Anahtar Kelimeler

• gebelik, koryoamniyonit, Staphylococcus aureus

Kaynakça

1. Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol, 2010; 37(2): 339-54.
2. Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A casecontrol study of chorioamniotic infection and histologic chorioamnionitis in prematurity. N England J Med, 1988; 319(15): 972-80.
3. Burke C, Chin EG. Chorioamnionitis at term. Definition, diagnosis, and implications for practice. J Perinat Neonat Nurs, 2016; 30(2): 106-14.
4. Berber M, Çekmez F, Purtuloğlu T. Fetus için gizli bir tehlike: Koryoamniyonit. J Clin Anal Med, 2014; 5(5): 432-7.
5. Sorano S, Goto M, Matsuoka S,Tohyama A, Yamamato M, Nakamura S, et al. Chorioamnionitis caused by Staphylococcus aureus with intact membranes in a term pregnancy: A case of maternal and fetal septic shock. J Infect Chemother, 2016; 22(4): 261-4.
6. Ben-David Y, Hallak M, Evans MI, Abramovici H. Amnionitis and premature delivery with intact amniotic membranes involving Staphylococcus aureus. A case report. J Reprod Med, 1995; 40(6): 485-6.
7. Geisler JP, Horlander KM, Hiett AK. Methicillin resistant Staphylococcus aureus as a cause of chorioamnionitis. Clin Exp Obstet Gynecol, 1998; 25(4): 119-20.
8. Negishi H, Matsuda T, Okuyama K, Sutoh S, Fujioka Y, Fujimoto S. Staphylococcus aureus causing chorioamnionitis and fetal death with intact membranes at term. A case report. J Reprod Med, 1998; 43(4): 397-400.

9. Fowler P. Methicillin-resistant Staphylococcus aureus chorioamnionitis: a rare cause of fetal death in our community. Aust N Z J Obstet Gynaecol, 2002; 42(1): 97-8.
10. Lacoste A, Torregrosa A, Dubois S, Apere H, Oyharcabal V, Carre M, et al. Maternal-fetal staphylococcal toxic shock syndrome with chorioamniotitis. Arch Pediatr, 2006; 13(8): 1132- 4.
11. Sherer DM, Dalloul M, Salameh G, Abulafia O. Methicillin-resistant bacteremia and chorioamnionitis after recurrent marsupialization of a bartholin abscess. Obstet Gynecol, 2009; 114(2): 471-2.
12. Pimentel JD, Meier FA, Samuel LP. Chorioamnionitis and neonatal sepsis from community-associated MRSA. Emerg Infect Dis, 2009; 15(12): 2069-71.
13. Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol, 1989; 161(3): 562-6.
14. Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intra-amniotic infection. Am J Obstet Gynecol, 1991; 164(5): 1317-26.
15. Sperling RS, Newton E, Gibbs RS. Intraamniotic infection in low-birth-weight infants. J Infect Dis, 1988; 157(1): 113-7.
16. Soper DE. Infections of the female pelvis. In: Bennett JE, Dolin R, Blaser JM eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Eigth edition. Philadelphia: Elsevier Saunders, 2015: p 1372-80.